If Howell-Jolly bodies are seen in the peripheral blood smear, and if an explanation is not readily apparent, then the patient should be evaluated for the presence of the spleen and splenic function. Patients found to be hyposplenic or asplenic require special management to prevent severe, life-threatening infections.


Step 1: Perform an abdominal ultrasound.


Step 2: If the spleen is present, then perform a liver-spleen scan with Technetium-99m.


Abdominal Ultrasound

Liver-Spleen Scan


spleen absent


hyposplenia or asplenia

spleen present

normal uptake

normal splenic function

spleen present

no or markedly decreased uptake

functional hyposplenism or functional asplenia


Causes of hyposplenia or asplenia:

(1) splenectomy (a person with a history of splenectomy may have some residual splenic function if a partial resection, multiple spleens or splenosis are present.

(2) congenital asplenia

(3) post-radiation splenic atrophy


If the spleen is present and splenic function is normal, then evaluate the patient for other causes of abnormal red blood cell morphology, including

(1) megaloblastic anemias

(2) hemolytic anemia


If functional hyposplenism/asplenia is present, then try to determine the cause:

(1) potentially reversible: infection, therapy-related, etc.

(2) irreversible: infarction, replacement, etc.


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